Healthcare Provider Details

I. General information

NPI: 1639648512
Provider Name (Legal Business Name): SAMANTHA LEA CLAUD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SWAN ST
CENTERVILLE TN
37033-1446
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-3091
  • Fax: 931-729-0809
Mailing address:
  • Phone: 615-284-4029
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24717
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number24717
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: